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Individual differences in personality, immunology and mood in patients undergoing self‐hypnosis training for the successful treatment of a chronic viral illness, HSV‐2
Abstract
Individual differences in personality, in particular cognitive activation, withdrawal and hypnotic susceptibility were examined in a study of self-hypnosis training in patients with chronic and severe herpes simplex virus (HSV-2), genital herpes, along with depression, anxiety and activation ratings. Immune parameters were assayed before and after the six-week training. Self-hypnosis almost halved recurrence rate, benefiting 65% of the patients. Furthermore clinical responders demonstrated an increase in natural killer cell (NKC) cytotoxicity of herpes infected cells as well as up-regulation of nonspecific immune parameters. In replication of a student exam stress study (Gruzelier, Smith, Nagy and Henderson, 2001a) cognitive activation was positively associated with immune function; with improvement in herpes recurrence, improvements in specific NKC cytotoxicity, baseline functional NKC activity and energy ratings, and was unrelated to frequency of practice. No other measure of personality or affect was associated with immune system up-regulation and improvements in health. Depression and, to a lesser extent, anxiety improved independently of herpes outcome. Depression and/or anxiety at baseline were positively associated with withdrawal, particularly the affective aspects, and neuroticism, which were associated with immune down-regulation seen in NKC counts and NKC functional activity at baseline. Hypnotizability was associated positively with aspects of immune system up-regulation and negatively with clinical depression. Immune system up-regulation in clinical responders correlated positively with frequency of self-hypnosis practice. This is possibly the first evidence for the efficacy of self-hypnosis training for a chronic medical illness. Evidence (1) of the benefits to health and (2) of the viral specificity of the immune changes, here in the form of increased cytotoxicity of NKC for cells infected with the herpes virus, gives credence to the value of a psychological intervention for immunity; evidence for which is scarce in the field of psychoneuroimmunology. The predictive ability of cognitive activation for response to hypnotherapy is in keeping with the preferential effects on both immune parameters and health of hypnosis instructions which require the generation of dynamic imagery in contrast to instructions of passive relaxation imagery (Gruzelier, Levy, Williams and Henderson, 2001b). Copyright © 2002 British Society of Experimental and Clinical Hypnosis
... Hypnotizability measured in patients at early stages of HIV infection correlated with the efficacy of stress-reduction procedures including self-hypnosis training in buffering the decline in CD4 counts, a marker of immune compromise in HIV . Selfhypnosis training has shown demonstrable benefits in buffering the effects of stress on the immune system in sustaining health and well-being, including a reduction in recurrences of chronic viral infection (Kiecolt-Glaser et al., 1996;Gruzelier, Levy, et al., 2001;Gruzelier, Smith, et al., 2001;Gruzelier, Champion, et al., 2002;Gruzelier, 2011). Santarcangelo and Sebastiani (2004) in a review in this journal inferred a possible adaptive role of hypnotic susceptibility as a natural protection against cardiovascular hazard, finding that only hypnotically susceptible participants were able to actively suppress cardiovascular responses evoked by a moderate mental stress. ...
... Hypnotizability measured in patients at early stages of HIV infection correlated with the efficacy of stress-reduction procedures including self-hypnosis training in buffering the decline in CD4 counts, a marker of immune compromise in HIV . Selfhypnosis training has shown demonstrable benefits in buffering the effects of stress on the immune system in sustaining health and well-being, including a reduction in recurrences of chronic viral infection (Kiecolt-Glaser et al., 1996;Gruzelier, Levy, et al., 2001;Gruzelier, Smith, et al., 2001;Gruzelier, Champion, et al., 2002;Gruzelier, 2011). Santarcangelo and Sebastiani (2004) in a review in this journal inferred a possible adaptive role of hypnotic susceptibility as a natural protection against cardiovascular hazard, finding that only hypnotically susceptible participants were able to actively suppress cardiovascular responses evoked by a moderate mental stress. ...
Cognitive and neurobiological evidence supports the premise that hypnotic susceptibility is a trait underpinned by neurocognitive and biological flexibility. Here it is proposed that this flexibility may represent an exceptional ability, one often associated with creativity, and a vulnerability inter alia for psychopathology. Associations with vulnerability were prompted by evidence from three investigations showing positive correlations between items from a schizotypy scale and hypnotic susceptibility. These belonged essentially to positive syndromes of schizotypy encompassing unreality experiences and cognitive activation, as well as to a nonspecific factor, social anxiety. Items included vividness of thoughts and perceptions, belief in psychic phenomena, rapid free flowing divergent thoughts, and perceptual alteration. Personality correlates of hypnotizability on occasion have disclosed corresponding cognitive phenomena including perceptual alteration, vividness of imagery, fantasy proneness, absorption, imaginative involvement, and creativity. Associations between hypnotisability and psychopathology have been proposed since the 19th century with warnings about precipitating psychosis in vulnerable individuals, issues which have been overlooked latterly or explained away. Schizotypy and psychosis have been associated with exceptional ability as well as psychopathology, while as with hypnotisability they may be adaptive traits with evolutionary advantages. Together this evidence is construed as support for primary associations of hypnosis with predominantly positive and nonspecific schizotypal features (though further research with negative schizotypy is warranted) and a vulnerability for psychopathology. These putative relations may provide fresh leads about the enigmatic nature of hypnotisability and procedures for identifying vulnerable individuals.
... It is well known that anxiety and stress can evoke herpes outbreaks. A follow-up study examined the effects of self-hypnosis training using dynamic imagery (rather than just passive relaxation imagery) with chronic and severe herpes simplex virus genital herpes [35]. Immune measures were performed prior to and following 6 weeks of self-hypnosis practice. ...
... Both these techniques were taught as self-hypnosis after a group training period. Hypnotic visualization included the classical 'sharks' cleaning up the bloodstream used successfully with medical students in the past and patients with chronic genital herpes (Fox, Henderson, Barton, Champion, Rollin, Catalan, McCormack, Gruzelier, 1999;Gruzelier, Champion, Fox, Rollin, McCormack, Catalan, Barton, Henderson, 2002), and shown to be superior to an hypnotic relaxation intervention . These specific images were used together with getting participants to create their own scenarios (Laidlaw, Booth, and Large, 1996) and thus potentiate the emotional content of the visualization. ...
This is a small pilot study using two psychological interventions aimed at maintaining health and well-being in women with metastatic breast cancer. Out of 100 women deemed eligible, 37 were randomly assigned to 4 weeks of training in self-hypnosis or to a Japanese healing method, Johrei, or to a wait-list control condition for three months. Participants were examined with quality of life and mood scales on two occasions, prior to training and again three or more months later. Most data were able to be collected on 14 participants. Following both interventions, patients were more composed and less anxious than controls. Hypnosis training increased and Johrei patients maintained energy levels. There was a positive change in anxiety levels and a general increase in other mood scores. Such results are relevant to a better quality of life. In conclusion, the participants in this pilot study appear to have benefited by not only maintaining but also often increasing their energy levels and decreasing anxiety and other debilitating emotional states that influence quality of life, health and well-being. Copyright © 2005 British Society of Experimental and Clinical Hypnosis
... People high in absorption commonly report having highly focused experiences such as feeling like a character in a story when losing themselves in a good book. There are psychophysiological correlates of hypnotic ability in the autonomic (Harris, Porges, & Carpenter, 1994); immune (Gruzelier et al., 2002); and central nervous system (Graffin, Ray, & Lundy, 1995). ...
The importance of measuring hypnotic ability as an important first step in mind/body medicine is reviewed. Knowledge of a client’s hypnotic ability and phenomenological experience of hypnosis is of critical value when determining the ideal integration of hypnosis and biofeedback for that person. Differences in empathic disposition appear to underlie why low hypnotizable persons prefer using biofeedback at the onset of psychotherapy, as well as why high hypnotizable persons are recommended to
begin with hypnosis. Low hypnotizable persons appear to enjoy the biomedical validation of applied psychophysiology, whereas high hypnotizable persons can utilize their empathic gifts in hypnosis.
... Some studies have even suggested that this immune system enhancement in cancer patients can be translated in longer survival although further studies are required to clarify this (Walker,). Three recent investigations by John Gruzelier and his colleagues (Gruzelier, Smith, Nagy and Henderson, 2001a; Gruzelier, Levy, Williams and Henderson, 2001b; Gruzelier, Champion, Fox, Rollin, McCormack, Catalan, Barton and Henderson, 2002) with self-hypnosis training incorporating imagery of the immune system are particularly relevant. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. ...
Despite conclusive evidence for the efficacy of clinical hypnosis in the management of many cancer related symptoms and particularly acute and chronic pain, hypnosis is cur-rently under-utilized in these applications. This paper gives a brief overview of the con-temporary uses of hypnosis in paediatric and adult oncology and shows how hypnosis can be integrated into a total therapeutic process based on the needs and goals of the patient and the health care team treating them. The first section describes studies that have evaluated hypnosis in adult oncology. The second half consists of a review of the hypnosis literature in paediatric oncology. The paper concludes with suggestions for future research, and implications for clinical practice, which at the moment lags behind.
... Positive words increase the ability to cope in stressful situations (Levy and Hausdorff, 2000); and older people exposed to subliminal positive words walk more steadily and are cognitively improved (Levy, Ashman and Dror, 1999). It has also been shown that hypnotic visualization improves the HADS scale in clinical studies using taped hypnosis (Gruzelier, Champion, Fox, Rollin, McCormack, Catalan, Barton and Henderson, 2002). Research examining the way CBT works, has found that it reduces relapse in depression 'by changing relationships to negative thoughts rather than by changing belief in thought content' (Teasdale et al., 2002). ...
The impact on health status of hypnosis was investigated in a primary care NHS GP surgery clinic, with referrals from a Local Health Care Cooperative (LHCC) with 85,000 patients. The Medical Outcomes Study Short Form-36 Health Survey (SF36) pre and post treatment was completed by patients referred with mental health problems, medical problems and for smoking cessation. One hundred and fifteen patients successfully completed SF36 questionnaires before and six weeks after the intervention. Categories of treatment were smoking cessation, mental health, and medical. In the case of referrals for smoking cessation there were no significant changes in mental, social or physical function six weeks after the intervention. In the case of mental health referrals, which were predominantly anxiety related, there was a large and significant effect on the SF-36 in emotional role and mental role and a moderate effect on social role and mental health. Self-hypnosis was in widespread use after treatment, even in those whose perceived problem appeared not to have improved. The results suggest that simple hypnosis techniques could have a significant impact on mental health. This could have implications for promoting mental health as well as for treating mental illness, and needs to be tested further by a randomized, controlled trial. Copyright © 2004 British Society of Experimental and Clinical Hypnosis
... The diversity of therapeutic applications for hypnosis range from the controversial age-regression techniques used to uncover past traumatic experiences which need to be processed to alleviate current ailments, to analgesia, phantom limb pain (Oakley & Kalligan, 2002), changing unwanted behaviour like smoking, snoring and eating habits (Kraft, 2003), bed-wetting, improving concentration and recall for students, as well as enhancing performance in various other settings including competitive sport. Recently, hypnosis has also been proven effective in enhancing the functioning of the immune system (Gruzelier et al., 2002; Seidman, 1999), extending possibilities for its application to the HIV pandemic in South Africa. ...
The current study investigates intercultural differences in suggestibility between Black, Coloured and White students at a South African university using the Creative Imagination Scale (CIS), (Wilson & Barber, 1978). The CIS and a short biographical questionnaire measuring embeddedness in traditional culture were administered to three samples (N=20 each) from students belonging to the above cultural groups. Statistical tests were applied to determine the effects of ethnicity, cultural embeddedness and gender on CIS scores. The results indicate that these three dimensions do not significantly impact on CIS scores. Implications of the results obtained are discussed and ensuing recommendations for future related research are made. Thesis (MA (Psychology))--University of Stellenbosch, 2005.
... It is well known that anxiety and stress can evoke herpes outbreaks. A follow-up study examined the effects of self-hypnosis training using dynamic imagery (rather than just passive relaxation imagery) with chronic and severe herpes simplex virus genital herpes [35]. Immune measures were performed prior to and following 6 weeks of self-hypnosis practice. ...
Self-hypnosis training represents a rapid, cost-effective, nonaddictive and safe alternative to medication for the treatment of anxiety-related conditions. Here we provide a review of the experimental literature on the use of self-hypnosis in the treatment of anxiety and stress-related disorders, including anxiety associated with cancer, surgery, burns and medical/dental procedures. An overview of research is also provided with regard to self-hypnotic treatment of anxiety-related disorders, such as tension headaches, migraines and irritable bowel syndrome. The tremendous volume of research provides compelling evidence that hypnosis is an efficacious treatment for state anxiety (e.g., prior to tests, surgery and medical procedures) and anxiety-related disorders, such as headaches and irritable bowel syndrome. Although six studies demonstrate changes in trait anxiety, this review recommends that further randomized controlled outcome studies are needed on the hypnotic treatment of generalized anxiety disorder and in documenting changes in trait anxiety. Recommendations are made for selecting clinical referral sources.
... Recorded hypnosis material can also employ the powerful effect of positive words and concepts. It has also been shown that a hypnotic visualization of white blood cells as dolphins significantly reduced recurrence of herpes simplex infections and improved the Hospital Anxiety and Depression Scale scale in clinical studies that used taped hypnosis (Gruzelier et al., 2002); self-hypnosis using taped material is as effective as hetero-hypnosis (presence of a hypnotist) (Unestahl, 1973). Along with the potential for increased engagement due to a reduction in stigma, access, and literacy problems, these factors constituted the central justification for our study. ...
This investigation assessed the effectiveness of a self-help, self-hypnosis treatment in a primary-care setting in Edinburgh, UK. A partially randomized preference (PRP) study design was used, with benchmarking results to trials of CBT and counseling. Patients seeing their general practitioner for depression were offered randomization to, or their treatment preference of, either self-help (self-hypnosis) or antidepressant medication. Evaluation measures were Becks Depression Inventory, Brief Symptom Inventory, and SF-36. Of the 58 patients recruited, 50 chose self-hypnosis, 4 chose antidepressants, and 4 were randomized. The preference groups demonstrated similar demography, baseline measurements, and outcome effects to benchmarked trials. This feasibility study of a self-help, self-hypnosis program for depression showed promise for its future use in primary care. Benchmarking improved validity and reliability. A PRP study design appeared useful in a primary-care setting, where past studies have experienced problems of recruitment, concordance, and compliance.
Background
Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises evidence for the effectiveness of non-pharmacological treatments for symptoms of PVS. It also summarises the symptoms and health impacts of PVS in individuals recruited to studies evaluating treatments.
Methods and findings
We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 st January 2001 to 29 th October 2021. We anticipated that there would be few RCTs specifically pertaining to Long COVID, so we also included observational studies only if they assessed interventions in individuals where the viral pathogen was SARS-COV-2. Relevant outcome data were extracted, study quality appraised using the Cochrane Risk of Bias tool, and the findings were synthesised narratively. Quantitative synthesis was not planned due to substantial heterogeneity between the studies. Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients.
Conclusions
In this study, we observed a lack of robust evidence evaluating non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS as well as what may work for certain sub-groups of patients with differential symptom presentation.
Registration
The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.
Author summary
Why was this study done?
The prevalence of Long COVID following exposure to SARS CoV-2 is substantial, and the current guidance provides few evidence-based treatment options for clinicians to suggest to their patients.
Due to the similarities in presentation of other post-viral syndromes (PVS), and the lack of consensus in management approaches, there is a need to synthesise the available data on PVS to both support patients with PVS predating the pandemic, and those with Long COVID.
What did the researchers do and find?
This is the first comprehensive systematic review of the effectiveness of non-pharmacological treatments for patients with PVS, including Long COVID.
We identified four non-pharmacological treatments (Pilates, telerehabilitation, resistance exercises and neuromodulation) which have shown promise in those who have experienced signs and symptoms related to PVS.
What do these findings mean?
In this study, we identified few trials assessing the effectiveness of non-pharmacological therapies to support the management of symptoms of PVS. Considering the prevalence of PVS, including Long COVID, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological therapies to support these patients.
Objective:
This review sought to identify the experiences of persons living with genital herpes and what interventions improve the health-related quality of life of young people and adults with primary or recurrent genital herpes.
Introduction:
Genital herpes is commonly associated with psychosocial challenges. However, a growing body of evidence suggests that its impact can be ameliorated through pharmacological and psychosocial interventions.
Inclusion criteria:
This review considered English- and German-language studies of community-dwelling males and females, of any ethnicity and geographical location, aged 15 years and older, who had primary or recurrent genital herpes. The quantitative component of the review included studies that reported on the virus' impact on patients' health-related quality of life and/or the efficacy of interventions in improving their health-related quality of life. Studies compared antiviral suppression therapies and psychological interventions with usual care or placebo, or against one another. The qualitative component of the review included studies that investigated the perceptions and experiences of young people and adults with genital herpes.
Methods:
Eleven databases were searched from January 1980 to March 2020. The JBI approach to mixed methods systematic reviews was followed at each stage of the review, and a convergent segregated approach to synthesis and integration was adopted.
Results:
A total of 31 publications covering 30 studies were deemed suitable for inclusion. Studies encompassed quantitative (n=27, across 28 publications), qualitative (n = 1), and mixed methods (n = 2) designs. Critical appraisal scores were variable, particularly among the randomized controlled trials and the analytical cross-sectional studies. All studies were included regardless of methodological quality.The quantitative components identified that depression, illness concern, stress, anxiety, isolation, stigma, and a lowering of self-esteem, self-concept, self-confidence, and health-related quality of life may be experienced by both those newly diagnosed with genital herpes and those with recurrences. It was also identified that genital herpes can have an adverse effect on work or school, sexual relationships, and relationships with friends and family. Depression was found to significantly decrease after self-hypnosis and certain psychosocial interventions. Anxiety significantly decreased following pharmacological treatment, psychosocial interventions, and hypnosis. Psychosocial interventions significantly improved mood, and a self-help module with counseling significantly improved participants' satisfaction with intimate relationships and their self-esteem. Pharmacological treatment significantly improved health-related quality of life; however, there were no significant differences between different active treatment regimens.The qualitative component of the review led to the identification of two synthesized findings: "Disclosure of a diagnosis of genital herpes poses a dilemma for people who have the virus" and "A diagnosis of genital herpes has a significant emotional impact for the individual."Integration of quantitative and qualitative evidence revealed a consensus that a diagnosis of genital herpes has a significant emotional impact for individuals and that disclosure is stressful, affects relationships, and affects health-related quality of life; however, there is a lack of consensus regarding efficacy of different interventions.
Conclusions:
Genital herpes can lead to extreme emotional, social, relational, and sexual distress, but there is insufficient knowledge concerning which interventions best improve health-related quality of life. More high-quality research is required.
Hypnosis and neurofeedback each provide unique therapeutic strengths and opportunities. This paper provides an overview of some of the research on neurofeedback and hypnosis. The author’s perspective and recommendations are provided on the relative clinical utility of using either neurofeedback or hypnosis as the initial treatment of choice with various clinical conditions.
Before course examinations, 48 university students were randomized to four weeks of training in self-hypnosis, a Japanese method for enhancing well-being, Johrei, or to a control procedure shown to produce self-reported relaxation and consisting of EEG-biofeedback with false feedback. Participants were examined with mood scales, EEG and immune parameters on three occasions: prior to training, after the month of training, and again two to three months later. The mood results are reported here. Although all participants reported an increase in negative mood with exams, especially an increase in tension, both self-hypnosis and Johrei buffered the effects of exam stress relative to the control group on depression, confusion and loss of vigour. These were extended with Johrei to include self-rated anxiety, depression and anger, while self-hypnosis evinced advantages over Johrei on diary reports of mood post-training. The advantages immediately following training for self-hypnosis and Johrei over the control relaxation procedure were to a large extent sustained at follow-up, by which time home practice had reduced. Advantages were unrelated to expectations about outcome before training although beliefs after training were related to absorption abilities. Johrei appears a promising procedure for maintaining equilibrium of mood in the face of stress, despite the scepticism of the participants. Copyright © 2003 British Society of Experimental and Clinical Hypnosis
This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective.
In this paper we explore the meaning and experience of living with breast cancer that had returned after conventional treatment. We focus on the process of learning and applying a specific psychological intervention to aid with the coping process. Of sixteen women who were randomized to self-hypnosis training, Johrei training or a control wait-list group, eight agreed to be interviewed. Interviews were recorded, transcribed and then analysed using interpretative phenomenological analysis. The major themes that conceptualized living with the return of breast cancer were self-identity, self-blame, social isolation and feelings of being constrained. The themes relating to psychological intervention were gaining a sense of control and empowerment, normalizing and re-attribution, and a powerful military metaphor for dealing with the actual cancer. Copyright © 2006 British Society of Experimental & Clinical Hypnosis. Published by John Wiley & Sons, Ltd.
Fear of death, pain, or the recurrence of the illness of tumor patients can narrow their attention to a point where a spontaneous altered state of consciousness occurs. In these cases hypnosis either in formal psychotherapy or embedded into the everyday communication with the physician can effectively complement other already known medical and psychological techniques. Although numerous studies have reported the beneficial physical and mental changes induced by hypnosis, for a long time there were not enough research to affect evidence-based medicine. New studies meeting the most rigorous methodological standards, new reviews and the characteristics of hypnosis shown by neuroimaging techniques support the acceptance of this method. Hypnosis is used and studied with adult and child tumor patients alike mostly in the areas of anxiety, pain, nausea, vomiting, quality of life, mood amelioration, immune system and hot flushes. Most of the assays describe hypnosis as an empirically validated treatment technique that in most cases surpass attention diversion, coping trainings, cognitive behavior and relaxation techniques and other regular treatments. In this paper we review these observations.
To elucidate the association between stressful life events and the development of cancer the influence of life stress on relapse in operable breast cancer was examined in matched pairs of women in a case-control study. Adverse life events and difficulties occurring during the postoperative disease free interval were recorded in 50 women who had developed their first recurrence of operable breast cancer and during equivalent follow up times in 50 women with operable breast cancer in remission. The cases and controls were matched for the main physical and pathological factors known to be prognostic in breast cancer and sociodemographic variables that influence the frequency of life events and difficulties. Severely threatening life events and difficulties were significantly associated with the first recurrence of breast cancer. The relative risk of relapse associated with severe life events was 5.67 (95% confidence interval 1.57 to 37.20), and the relative risk associated with severe difficulties was 4.75 (1.58 to 19.20). Life events and difficulties not rated as severe were not related to relapse. Experiencing a non-severe life event was associated with a relative risk of 2.0 (0.62 to 7.47), and experiencing a non-severe difficulty was associated with a relative risk of 1.13 (0.38 to 3.35). These results suggest a prognostic association between severe life stressors and recurrence of breast cancer, but a larger prospective study is needed for confirmation.
The authors present a set of hypotheses about the biologic mechanisms of lateralization, ie, the processes which lead to an asymmetrical nervous system. It would have been difficult even 20 years ago to formulate such a theory in the face of the prevalent belief that cerebral dominance lacked an anatomic correlate. It is proposed that cerebral dominance is based in most instances on asymmetries of structure. Although genetic factors are important we will lay stress on several factors that, in the course of development, both prenatal and postnatal, modify the direction and extent of these structural differences. Special attention will be directed to the intra-uterine environment as a determinant of the pattern of asymmetries, and in particular sex hormones, eg, testosterone or related factors. We will discuss the associations of anamalous cerebral dominance which include not only developmental disorders such as dylexia and certain talents but also alterations in many bodily systems, including the immune system, the skin, and the skeleton. It is proposed that the same influences that modify structural asymmetry in the brain also modify other systems.
The progress of 58 patients with first attacks of genital herpes was monitored for up to 30 weeks. The effects of sex (gender), age, social class, and non-psychotic psychiatric illness (as measured by the "general health questionnaire," GHQ) on the recurrence rate of herpes was studied. The recurrence rates, measured by the actuarial percentage recurrence-free curves, showed that the 29 patients with GHQ scores above 11 had a significantly higher recurrence rate than those who scored less than 11 (P = 0.002). There were no important differences between recurrence rates according according to sex, age, or social class. These findings suggest that non-psychotic states, such as anxiety or obsessionality resulting in GHQ scores above 12, may possibly cause an excess production of adrenergic substances which encourages reactivation of latent genital herpes. Thus, to lessen the recurrence rate in such patients, a psychological or chemical approach to treatment could be used to modify the autonomic sympathetic response.
The mammalian response to stress involves the release of soluble products from the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. Cells of the immune system respond to many of the hormones, neurotransmitters, and neuropeptides through specific receptors. The function of the immune system is critical in the mammalian response to infectious disease. A growing body of evidence identifies stress as a cofactor in infectious disease susceptibility and outcomes. It has been suggested that effects of stress on the immune system may mediate the relationship between stress and infectious disease. This article reviews recent psychoneuroimmunology literature exploring the effects of stress on the pathogenesis of, and immune response to, infectious disease in mammals.
This article presents the results of two investigations, each measuring cellular immune function on 3 investigation days 1 week apart in 15 high and 15 low hypnotizable healthy subjects randomly selected for three groups: (1) a guided imagery group receiving instructions to enhance cellular immune function: (2) a relaxation group which did not receive instructions regarding the immune system, and (3) a control group. Study 1 investigated changes in monocyte chemotaxis (MC) and lymphocyte proliferative response (LPR) to three mitogens, while natural killer cell activity (NKCA) was measured in study 2. The results show similar patterns of brief decreases in LPR and NKCA immediately after intervention on all investigation days in both the imagery and relaxation groups. Increases in MC were found in both intervention groups on day 1. On a follow-up investigation day in study 2, a brief stress task yielded a slight increase in NKCA. In study 2, the control group showed decreases in NKCA similar to those observed in the two intervention groups. In general there were no significant changes in preintervention immune function throughout the investigation period. When comparing the effects in high and low hypnotizable subjects, we found that high hypnotizables showed greater decreases in LPR and NKCA than low hypnotizables. There are several inconsistencies between the results of the limited number of investigations studying the effects of guided imagery and relaxation on immune function. These differences may in part be explained by differences in methodology, time intervals between blood sampling, and subject characteristics such as age, health status and hypnotizability. The inconsistent results make it premature to make inferences about possible benefits of the application of these techniques in the treatment of immune related diseases, and further investigations are needed.
Many patients with genital herpes will have recurrences, and for some the recurrences may be frequent and severe and accompanied by profound psychosexual morbidity. Some patients can successfully be managed with intermittent courses of oral or topical acyclovir to be used with each recurrence. However this treatment is of limited efficacy, and longterm acyclovir suppression may be useful. This form of treatment is highly successful for patients with frequent recurrences most of whom will have no episodes during treatment. The optimum dosage for commencing acyclovir suppression is 200 mg four times daily, and the dose may subsequently be reduced. Some patients can successfully be managed on 400 mg twice daily. Treatment should be stopped after 1-2 years as there is some evidence of a decrease in the frequency of recurrences. Selecting patients for suppression should be based on the frequency, severity, and duration of recurrences as well as any associated emotional problems. Some patients may recur on suppression, usually due to inadequate dosage. Many patients with first episode genital herpes experience emotional and psychological problems. However these problems only continue if patients have recurrences and continued psychological support is essential. Long-term acyclovir suppression improves psychological well-being but is not a substitute for information, counselling, and expert psychosexual support.
To assess the psychological impact of first episode of genital herpes, and to determine whether this changes over time.
The Departments of Genitourinary Medicine (GUM), and Dermatology, Middlesex Hospital London. The study group consisted of patients attending the department of GUM with a clinically proven first episode of genital herpes. Two control groups were recruited; firstly patients without herpes attending the GUM Department and secondly patients attending the Dermatology Department out patients with chronic dermatoses.
Patients and controls completed an 87 item, self-administered psychological questionnaire at 3 monthly intervals for a year. The questionnaire consisted of the General Health Questionnaire (GHQ); the Hospital Anxiety and Depression Questionnaire (HADQ); Illness Attitude Scales and Illness Concern. Patients were also asked questions about their sexual behaviour.
Ninety one patients (68 women, 23 men) with genital herpes, 61 GUM controls (42 women, 19 men) and 56 dermatology controls (36 women, 20 men) participated. There were no statistically significant demographic differences between patients and controls. At first visit the proportion of patients classified as "cases" by the GHQ (GHQ cases) were similar for primary herpes patients 62% (56/91) and Dermatology controls 52% (29/56) while a significantly smaller proportion of GUM controls 34% (21/61) were classified as GHQ cases. The primary herpes group were significantly more concerned about their illness than either the GUM controls or the Dermatology controls (p < 0.002). The proportion of primary herpes patients classified as "cases" by the GHQ reduced significantly over the initial three month period with 67% of patients classified as "cases" at their first visit becoming "noncases" after three months (p < 0.0001). Also 50% of those classified as "cases" at first visit by the HADQ become "noncases" after the initial three months (p = 0.007). The illness concern scores also decreased significantly from visit one to visit two (means 14.7 vs. 12.3; p < 0.0001).
The diagnosis of a first episode of genital herpes has a profound emotional effect on patients. If they do not have recurrent episodes, their emotional state improves. For those who do have recurrences, the level of anxiety and concern remains as high as at the time of their first diagnosis. Clinicians must be sensitive to the emotional impact such a diagnosis may bring.
A meta-analysis indicated that clinical depression was associated with several large alterations in cellular immunity. Analyzing only methodologically sound studies, reliable immune alterations included lowered proliferative response of lymphocytes to mitogens (effect size rs = .24-.45), lowered natural killer cell activity (r = .28), and alterations in numbers of several white blood cell populations (rs = .11-.77). Immune alterations were greater in both older and hospitalized samples. There was also evidence of a linear relation between intensity of depressive affect and indicators of cellular immunity. Estimates of sample sizes needed to detect reliable effects for each immune outcome are provided. How neuroendocrine mechanisms or health practices might link depression to immunity is discussed, and design features needed to better understand these pathways are specified.
This study tested the effects of hypnosis on the immune response. High and low hypnotizable Ss were exposed to hypnosis, relaxation or control conditions. Blood samples obtained before treatment and twice thereafter were subjected to flow cytometry analysis. Significant alteration of the immune response as measured by B-cells and helper T-cells was shown only for highly hypnotizable Ss exposed to hypnosis.
In reviewing the neuropsychophysiological evidence of functional asymmetry it is proposed that schizophrenia is characterized by a greater dispersion of leftward and rightward asymmetries. The two extremes are represented by active (left greater than right) and withdrawn (right greater than left) syndromes, as is the case with psychometric schizotypy. Syndrome-asymmetry relations extended beyond fronto-temporal systems to include posterior activity, infracortical motoneuron excitability, and individual differences in interhemispheric connectivity and directional biases. Central to these are lateral imbalances in thalamo-cortical and callosal arousal systems, while centrality to schizophrenia follows evidence of reversals in asymmetry with changes in symptom profile, clinical recovery, and neuroleptic treatment. Affinities are found in intact animals from challenge-induced turning tendencies representing coordinated activity of attentional, motor, and reinforcement systems. In both patients and animals, neuroleptics have reciprocal interhemispheric effects, with a bidirectionality that depends on syndrome or endogenous turning preference. Bidirectionality implicates nonspecific thalamic system (NSTS) and not limbic projections. It is proposed that the asymmetries arise from endogenous influences of genes, hormones, and early experience including stressors on NSTS asymmetry, and these underpin approach/withdrawal behavior that is manifested in temperament, personality, and clinical syndrome, and which precedes language development.
This review considers psychological interventions involving relaxation and guided imagery targeting immune functions. The review provides evidence of immune control accompanied by reports of enhanced mood and well-being. Three recent investigations of the author and his colleagues with self-hypnosis training incorporating imagery of the immune system are outlined. In two studies, hypnosis buffered the effects of stress on immune functions in medical students at exam time, and the comparison of self-hypnosis with and without immune imagery confirmed advantages to targeted imagery for both immune function and mood, and importantly, fewer winter viral infections. The implications for health were investigated in a third study in patients with virulent and chronic herpes simplex virus-2 HSV-2). Six weeks of training almost halved recurrence, improved mood and reduced levels of clinical depression and anxiety. Immune functions were up-regulated, notably functional natural killer cell activity to HSV-1. Individual differences in hypnotic susceptibility and absorption have typically been found to predict efficacy. New replicable evidence is reviewed of the importance of cognitive activation, a personality difference whose neurophysiological underpinning is consistent with left hemispheric preferential influences over the immune system. Now that the validation of psychological interventions includes advantages for health, this field of enquiry, which has been characterised by modest, small scale, largely preliminary studies, warrants a greater investment in research.
One hundred patients with chronic arthritis were interviewed and completed questionnaires about coping, well-being and their use of humour. A comparison of patients scoring high or low on each of 3 measures of humour showed that those who reported they used humour least, had most difficulty recognising it and valued it least. They also reported more depressive symptoms and lower personal self-esteem. Regressions showed that depression was best predicted by the inactive use of humour in coping. and to a lesser extent, pain intensity. Cluster analysis of data on general coping strategies showed that valuing humour distinguished two-thirds of patients who were relatively normal and cautiously optimistic, from the other third, where the outlook was negative and hopeless. Those with a more positive view tended to be younger, less disabled, in less pain and with several social advantages on a number of indicators. However they also had a longer duration of disease. Two-thirds of patients said they were able to laugh when in pain but those most able to do this had less intense pain during the previous week. Furthermore the most disabled arthritis patients found laughter to be a most effective strategy. The research has implications for preventing depression and coping with disability.
We have been closet Cartesians in modern medicine, treating the mind as though it were reactive to but otherwise disconnected from disease in the body. Although medical science has productively focused on the pathophysiology of disease, such as tumor biology, coronary artery disease, and immunology, it has done so at the expense of studying the body's psychophysiological reactions to these disease processes. These reactions are mediated by brain and body mechanisms, including the endocrine, neuroimmune, and autonomic nervous systems. While a large portion of the variance in any disease outcome is accounted for by the specific local pathophysiology of that disease, some variability must also be explained by host resistance factors, which include the manner of response to the stress of the illness. For example, in a series of classic experiments in animals, Riley¹,2 showed that crowding accelerated the rate of tumor growth and mortality. In a recent authoritative review of human stress literature, McEwen³ documented the adverse health effects of cumulative stressors and the body's failure to adapt the stress response to them. Activation of the hypothalamic-pituitary-adrenal axis (HPA) is an adaptive response to acute stress, but over time, in response to cumulative stress, the system's signal-to-noise ratio can be degraded, so that it is partially "on" all the time, leading to adverse physiological consequences, including abnormalities of glucose metabolism,⁴ hippocampal damage,⁵ and depression.⁶,7
In a prospective study of 15 spouses of women with advanced breast carcinoma, lymphocyte stimulation responses to phytohemagglutinin, concanavalin A, and pokeweed mitogen were significantly suppressed during the first two months following the death of a spouse compared with prebereavement levels. A highly significant suppression was seen as early as one month after bereavement. No differences were found in total lymphocyte or B- or T-cell numbers. An intermediate level of mitogen responsivity was found during the four- to 14-month period after bereavement. Suppressed immunity following the death of a spouse may be related to the increased morbidity and mortality associated with bereavement.
(JAMA 1983;250:374-377)
While activation has proved to be a very useful concept in understanding behavior, theoretical and practical problems concerning physiological measurement have reduced its utility. Controlled self-report is suggested as an alternative measurement form, and data from several studies are presented indicating the validity of the Activation-Deactivation Adjective Check List (AD-ACL), an objective self-report measure of transient levels of activation. Factor analytic studies yielded four AD-ACL factors representing different points on a hypothetical continuum. These factors correlated substantially with physiological variables and reflected significant activation changes as predicted from diurnal sleep-wakefulness variations and from an impending college examination. The relative merits of self-report and individual peripheral physiological measures in the assessment of activation are discussed.
In three different studies involving exposun to two differcot humorous and comparison videotapes, it was demonstrated that humor arousal signiticantly increases S-IgA in college students. Furthermore significantly more of the subjects exposed to the humor films showed an increese in S-IgA than the subjects exposed to the comparison films. A good sense of humor, measured as a trait, was associated with higher baseline concentrations of S-IgA and with greater increases in S-IgA in response to a humor arousing film. Higher bascline kvels and gains in S-IgA in respoase to humor were associated with lower reported severity of colds in the past twelve months and in the three months following assessment. However, a good sense of humor was related to lesser cold incidence and severity only if it involved appreciation rather than production of humor. While those who actively tell jokes also show higher S-IgA levels, they show greater susceptibility to colds than those who only appreciate humor probably because they sodalize more often under conditions that expose them more to cold infections.
Negative mood (e.g., emotional distress) is known to affect immune function, but little research has addressed effects of positive mood. In the present study, positive and negative mood (over a day) were examined for their relations to natural killer cell activity (NKCA) in 48 healthy women. Results indicated that women reporting some negative mood (N = 26) had lower levels of NKCA than women who had no negative mood, while those with higher levels of positive mood had higher NKCA. However, as indicated by the significant interaction between positive and negative mood, the relation between positive mood and NKCA depended upon the women's experience of negative mood. Higher levels of positive mood were related to higher levels of NKCA only among the women who reported having some negative mood over the day. These results raise the possibility that positive mood may moderate, or buffer, the effects of negative mood on immune function.
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Reviews research on the psychological antecedents of cancer and the influence of psychological factors on the course of the disease. Although interpretation of these studies is made problematic by methodological difficulties and conflicting results, there is some evidence suggesting that the development of cancer may be related to the occurrence of stressful experiences, depression, and personality attributes such as emotional inhibition and extraversion. Poorer outcome has been associated with severe emotional stress and feelings of helplessness. (76 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
contains critical analysis of the following questions: are there neuropsychophysiological differences between low and high hypnotizable individuals in nonhypnotic (waking) or hypnosis conditions / are there any systematic changes in such neuropsychophysiological processes during hypnotic rest or during specific hypnotic phenomena that differ from those obtained in nonhypnotic conditions / are these moderated by a hypnotic susceptibility level (PsycINFO Database Record (c) 2012 APA, all rights reserved)
localization of function / structural versus functional impairment
bilateral electrodermal activity / multiple central determinants, hemispheric influences and individual differences in habituation, laterality of pain in migraine, and syndromes in schizophrenia
cortical-subcortical and limbic system dysfunction in schizophrenia / P300, brain-stem and middle latency evoked potentials, callosal transmission
smooth-pursuit eye movements
cerebral laterality / normal and pathological anxiety, pain, hyperventilation, psychoneuroimmunology
therapeutic intervention / hypnosis
brain electrical activity mapping (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A multidimensional measure of schizotypal personality, the Personality Syndrome Questionnaire (PSQ) was completed by 83 undergraduate medical students. It was predicted that perceptual and cognitive reality distortions would be positively associated with hypnotic susceptibility. Fifteen of 84 items showed the predicted association. When combined into a preliminary scale, a correlation of 0.43 was found for the total scale score and susceptibility. Cronbach's alpha for this scale was acceptable at 0.77. These preliminary results are potentially vulnerable to type I error. Replication on a larger sample and factorial analysis of the proposed scales structure are required and underway. Copyright © 2001 British Society of Experimental and Clinical Hypnosis
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Imagery instructions specifying mucosal immunity should alter mucosal immunoglobulin A (m-IgA) levels in high absorbers, whose intent concentration evokes intense physiological responses. After screening for health status, 121 high or low absorbers were randomly assigned to either Relaxation Alone (R), Relaxation with Mucosal Immune Imagery (RI), or Vigilance Task control (VT). Before and after one 60-min intervention, subjects reported theory-relevant psychological variables and provided 5ml whole saliva, which was immediately frozen and assayed lateren masse with enzyme-linked immunoabsorbence (ELISA). MANOVA analysis of psychological variables replicated past research. ANOVA on residualized m-IgA found Time Absorption interaction and Condition main effects. High more than low absorbers responded to relaxation with mucosal immune imagery by producing higher m-IgA. High absorbers appear able to locate where their immune systems will respond. Individual differences like absorption level need to be emphasized in diagnosis and treatment responsiveness.
With regard to both the Barber Suggestibility Scale (BSS) and the Creative Imagination Scale (CIS), this paper discusses why and how they were constructed, how they have been used in the past, and how they will probably be used in the future. The paper also presents norms for both scales and data pertaining to their reliability and validity. To make the scales readily available for researchers and clinicians, all of the BSS and all of the CIS, together with scoring criteria, are presented in two appendices.
The relation between brain activity and the immune system was evaluated by assessing immune responses in 20 healthy women who manifested extreme differences in the asymmetry of frontal cortex activation. One group showed extreme and stable left frontal activation; the other group showed extreme and stable right frontal activation. As predicted, women with extreme right frontal activation had significantly lower levels of natural killer cell activity (at effector:target cell ratios of 33:1 and 11:1) than did left frontally activated individuals. This difference did not extend to two other immune measures, lymphocyte proliferation and T-cell subsets. However, higher immunoglobulin levels of the M class were observed in the right frontal group. In this study, the immune patterns could not be accounted for by plasma cortisol levels, anxiety- and depression-related symptomatology, or recent health histories. These findings support the hypothesis that there is a specific association between frontal brain asymmetry and certain immune responses.
This article provides a review of empirical evidence linking emotional processes to immune function in humans. Acute stressors have produced mixed effects on immunity, presumably through differential activation of physiological stress systems. Chronic stress has been associated with suppression of immune function, and there is evidence that the immune system may not adapt over time. Effects of stress accompanying social disruption and psychological depression, when demonstrated, have been consistently adverse. Certain personality styles may enhance or degrade immune response. Relationships between psychosocial factors and immunity have been identified for several diseases, including cancer, acquired immune deficiency syndrome, and autoimmune diseases; psychosocial interventions have been tested with variable results. Theoretical and methodological considerations are summarized and directions for future research suggested.
In a prospective randomized controlled study, the possibility that children could regulate their own salivary immunoglobulins was investigated using cyberphysiologic techniques. Fifty-seven children were randomly assigned to one of three groups. Group A subjects learned self-hypnosis with permission to increase immune substances in saliva as they chose; group B subjects learned self-hypnosis with specific suggestions for control of saliva immunoglobulins; group C subjects were given no instructions but received equal attention time. At the first visit, saliva samples (baseline) were collected, and each child looked at a videotape concerning the immune system and was tested with the Stanford Children's Hypnotic Susceptibility Scale. At the second visit, an initial saliva sample was collected prior to 30 minutes of self-hypnosis practice or conversation. At the conclusion of the experiment, a third saliva sample was obtained. Salivary IgA and IgG levels for all groups were stable from the first to the second sampling. Children in group B demonstrated a significant increase in IgA (P less than .01) during the experimental period. There were no significant changes in IgG. Stanford Children's Hypnotic Susceptibility Scale scores were stable across groups and did not relate to immunoglobulin changes.
The effects of examination stress on some lymphocyte subpopulations and cellular immune responses are reported. Twelve undergraduate students of psychology in examination term were tested six weeks before the written examination (phase I), one day before the first or second examination day (phase II) and 12-14 days after the examination (phase III). A comparable control group of students not in examination was assessed in parallel in phase II. The percentage of circulating monocytes increased in phase II in the examination group whereas the percentage of large (probably activated) CD4 and CD8 cells decreased. There was also a decrease in the number of cells expressing the IL-2 receptor in phase II. The proliferative response of T-cells to antigens, mitogens and allogeneic cells decreased from phase I to phase III. Thus, acute examination stress has a detectable influence on certain cellular immunological functions.
This study used a prospective design to examine the influence of examination stress and loneliness on herpesvirus latency as measured by changes in antibody levels to three herpesviruses, Epstein-Barr virus (EBV), Herpes simplex type I (HSV-1), and cytomegalovirus (CMV). Three blood samples were obtained from 49 first-year medical students, with the first sample drawn 1 month before final examinations, the second on the first day of final examinations, and the third during the first week after their return from summer vacation. A median split on the UCLA Loneliness Scale divided subjects into high- and low-scoring loneliness groups. There were significant changes in the antibody titers to all three herpesviruses across the sample points, with the lowest levels found in the third (low stress) sample. High-loneliness subjects had significantly higher EBV antibody titers than low-loneliness subjects. These data suggest that stress-related immunosuppression can significantly modulate herpesvirus latency.
Thirty undergraduates screened for high absorption ability were randomly assigned to three conditions. The first condition consisted of relaxation alone (progressive muscle relaxation and focused breathing). The second one combined this same relaxation training with mental imagery of the immune system. The third condition served as an alertness or mild arousal control; in a vigilance task subjects discriminated between tones presented in variable inter-trial intervals. Subjects reported trial levels of tension and daily stress. Before and after the protocols, which lasted about 1 hour, salivary immunoglobulin A (SIgA), cortisol and catecholamines (saliva and plasma), mood states, and power motivation were assessed. Afterwards, subjects doing relaxation alone and with imagery had a higher level of SIgA than did the vigilance task control group, with a large effect size. When the influence of plasma cortisol was controlled, this immune effect size increased by half, mainly by doubling the SIgA level after relaxation alone. SIgA was significantly and negatively correlated with saliva norepinephrine. The saliva and plasma levels for the neuroendocrine variables appear to be independent. Yet some saliva measures (e.g., epinephrine) did correspond highly with other plasma measures (e.g., norepinephrine).
The prevalence of antibodies against members of the herpes virus group and the measles virus was studied in 539 patients with various psychiatric disorders. Patients with unipolar or bipolar depressive psychoses and senile or artherosclerotic dementia had a significantly higher incidence of herpes simplex virus and cytomegalovirus antibodies than was found in schizophrenics or patients with other psychiatric disorders or in groups of healthy controls. In addition, the occurrence of neutralizing antibodies against herpes simplex virus type I was examined in 9 criminals with a history of aggressive behavior and in 8 criminals with psychiatric disorders who were not considered to be aggressive. No statistically significant difference in prevalence or titers between the two groups was demonstrable. The results are discussed against the background of recent findings of the effect of virus infections on brain monoamine metabolism and observations of viral latency in CNS infections.
Although various stressors appear to influence herpesvirus infections, the underlying mechanisms have not been studied. A prospective design was used to examine the effects of examination stress and loneliness on the transformation of B lymphocytes in mixed cultures of T and B lymphocytes by Epstein-Barr virus (EBV). Three blood samples were drawn from 42 EBV-seropositive medical students, with the baseline sample taken 1 month before their final examinations, the stress sample drawn on the first day of final examinations, and the third sample taken the first week after their return from summer vacation. A median split on the UCLA Loneliness Scale divided the subjects into high- and low-scoring loneliness groups. There were significant effects for change over trials, with the lowest transformation levels (i.e., more virus required to transform cells) found in the stress sample. There was also a significant main effect for loneliness, in which high loneliness was associated with lower transformation levels. Possible immunological pathways for the observed changes are discussed.
1848, as every student of history knows, was a revolutionary year in Europe. During that year, a minor, long forgotten revolution occurred in London medical circles when a physician, John Elliotson, published a paper entitled ‘Cure of a true cancer of the female breast with mesmerism’ (Elliotson, 1848). It is, as far as I can ascertain, the first recorded case of its kind. The author hypnotized his patient, a 42-year-old single woman, for “5 years and upwards … and for the greater part of the period three times a day”; during that time, Elliotson observed a ‘cancerous tumour’ in her right breast shrink away completely. No less than seven physicians and surgeons independently attested to the diagnosis of breast cancer, but no pathological examination was carried out. Elliotson was roundly abused, not for using hypnosis to treat cancer, but for using hypnosis at all—a practice condemned by certain physicians of fervid imagination as “indecent, disgraceful … liable to excite lascivious passions … an infernal system … the workings of Satan” (Elliotson, 1848).
In a prospective study of 15 spouses of women with advanced breast carcinoma, lymphocyte stimulation responses to phytohemagglutinin, concanavalin A, and pokeweed mitogen were significantly suppressed during the first two months following the death of a spouse compared with prebereavement levels. A highly significant suppression was seen as early as one month after bereavement. No differences were found in total lymphocyte or B- or T-cell numbers. An intermediate level of mitogen responsivity was found during the four- to 14-month period after bereavement. Suppressed immunity following the death of a spouse may be related to the increased morbidity and mortality associated with bereavement.
This study evaluates whether recently widowed women who fulfill criteria for a depressive syndrome differ in their immune responses from widows who do not. Twenty-one middle-aged widows who had lost their spouses 2 months before the initial evaluation and 21 demographically matched married women were evaluated at approximately 6-month intervals for 13 months. Evaluations consisted of diagnostic interviews using the Schedule for Affective Disorders and Schizophrenia, Hamilton Rating Scale for Depression, and Beck Depression Inventory. Immune function was measured by total lymphocyte counts, natural killer (NK) cell activity, mitogen responsiveness to concanavalin A, and T-cell subsets. There were no statistically significant differences on any of the immune measures between the entire cohort of widows and control subjects. However, the subset of widows who met DSM-III-R criteria for major depressive syndromes demonstrated impaired immune function (lower NK cell activity and lower mitogen stimulation) compared with those who did not meet criteria for major depression. This study suggests a relationship between impaired immune function and depression in women experiencing the stress of bereavement.
Immediate (Type I) hypersensitivity skin reactions to allergens or antigens have been used as immune measures that may be subject to intentional modulation. In preliminary experiments using hypnosis we encountered unacceptably large, uncontrollable variability. A method was subsequently devised in which serial, five-fold dilutions of allergen or histamine were administered to the subject's forearm and reactions were recorded photographically on slide film. Areas were determined by computer-assisted image analysis. Seven healthy volunteers were tested for eight sessions (testing included mood scales, blood pressure, pulse and skin temperature). Mean wheal size and titration gradient data from allergen reactions correlated strongly with the psychological factor of liveliness but not stress, although no manipulation of mood was involved. A stepwise regression analysis accounted for 61% of the variance of the allergen mean wheal data, and 31% was from the liveliness factor alone. Thus, the more lively the subject felt, the smaller was the allergic response.
Innate and adaptive forms of cellular immunity have important, interactive roles in host resistance to herpes simplex virus (HSV) infection. Hence, suppression of non-HSV specific and anti-HSV specific cellular immune responses can predispose the host to severe HSV infection. Studies using depletion and adoptive transfer of selected subpopulations of NK cells, macrophages, and CD4+ and CD8+ T lymphocytes indicate that each of these is of significance in protection against infection with HSV. Further evidence suggests that cytokines such as interferons alpha and gamma, interleukin 2 and leukocyte migration inhibition factor also have central roles in these cell functions during HSV infection. Of importance is that HSV itself can result in transient suppression of several innate and adaptive cellular immune responses during acute episodes of infection in normal adults. Mechanisms by which HSV may mediate this immune dysfunction include enhanced activity of suppressor T cells and soluble suppressor factors, decreases in cytokine production, decreases in expression of major and minor histocompatibility antigens and direct inhibition of cytotoxic effector cell function. Knowledge of anti-HSV cellular immunity and of the immunosuppressive properties of HSV are of importance in the development of appropriate treatment and vaccine strategies for this herpesvirus.
This study was a 19-week prospective conducted to determine the effectiveness of a self-hypnosis/relaxation intervention to relieve symptoms of psychological distress and moderate immune system reactivity to examination stress in 35 first-year medical students. Twenty-one subjects were randomly selected for training in the use of self-hypnosis as a coping skill and were encouraged to practice regularly and to maintain daily diary records related to mood, sleep, physical symptoms, and frequency of relaxation practice. An additional 14 subjects received no explicit training in stress-reduction strategies, but completed similar daily diaries. Self-report psychosocial and symptom measures, as well as blood draws, were obtained at four time points: orientation, late semester, examination period, and postsemester recovery. It was found that significant increases in stress and fatigue occurred during the examination period, paralleled by increases in counts of B lymphocytes and activated T lymphocytes, PHA-induced and PWM-induced blastogenesis, and natural killer cell (NK) cytotoxicity. No immune decreases were observed. Subjects in the self-hypnosis condition reported significantly less distress and anxiety than their nonintervention counterparts, but the two groups did not differ with respect to immune function. Nevertheless, within the self-hypnosis group, the quality of the exercises (ie, relaxation ratings) predicted both the number of NK cells and NK activity. It was concluded that stress associated with academic demands affects immune function, but immune suppression is not inevitable. Practice of self-hypnosis reduces distress, without differential immune effects. However, individual responses to the self-hypnosis intervention appear to predict immune outcomes.
Imagery instructions specifying mucosal immunity should alter mucosal immunoglobulin A (m-IgA) levels in high absorbers, whose intent concentration evokes intense physiological responses. After screening for health status, 121 high or low absorbers were randomly assigned to either Relaxation Alone (R), Relaxation with Mucosal Immune Imagery (RI), or Vigilance Task control (VT). Before and after one 60-min intervention, subjects reported theory-relevant psychological variables and provided 5 ml whole saliva, which was immediately frozen and assayed later en masse with enzyme-linked immunoabsorbence (ELISA). MANOVA analysis of psychological variables replicated past research. ANOVA on residualized m-IgA found Time x Absorption interaction and Condition main effects. High more than low absorbers responded to relaxation with mucosal immune imagery by producing higher m-IgA. High absorbers appear able to locate where their immune systems will respond. Individual differences like absorption level need to be emphasized in diagnosis and treatment responsiveness.
Prospective relations between individual differences in both lateralised neuro-psychophysiological functions and mood ratings with immune status (CD4 and CD8 counts) were examined in asymptomatic HIV-positive men (n = 27) over thirty months. They participated in a controlled study of zidovudine versus placebo (results published elsewhere). Measures included EEG spectra, neuropsychological tests and mood ratings. A model of reciprocal lateralised influences on the immune system was tested whereby patients with left superior to right hemispheric functions were predicted to show a less deleterious outcome than those with the opposite asymmetry pattern. Prospective relations with immune status were found in the EEG with lateralised theta, alpha and beta activity; among cognitive measures with word fluency, semantic processing, and lateralised motor and recognition memory (word/face) processes; with mood ratings including depression, confusion and the total mood score. The nature of the effects supported the laterality predictions. These unique data, showing that neuro-psychophysiological factors in HIV+ but otherwise healthy subjects predict immune competence and compromise present 2-3 years later, warrant replication in a larger cohort.
To review recent research into psychological aspects of genital herpes and assess possible implications for clinical practice.
Review of all papers in the field on Medline 1985-96.
Much attention has been paid to possible links between stress and recurrent genital herpes. There is no convincing evidence that stress in itself causes recurrences. It may be that recurrences are preceded by a prodromal period of altered mood. Patients with recurrences show considerable stress as a result of the disease, although most individuals eventually adjust psychologically. The impact of social support on adjustment remains unclear. The little evidence available suggests that antiviral treatments can help adjustment and the effects may perhaps outlast the period of active treatment.
Existing research gives some clues to optimal patient management but there is a need for future research to focus much more clearly on clinical issues, particularly on means of alleviating psychological distress and on the impact of antivirals.
The dynamics of stress-related decrease of salivary Immunoglobulin A (sIgA) were examined with respect to whether an increase of upper respiratory tract (URT) symptoms can be observed concurrently with or subsequent to sIgA alterations and whether one can use students' studying behavior during academic examinations to predict changes in sIgA. From a 2-part medical examination of 42 students, daily measures of sIgA were obtained, and symptoms of URT infections and studying behavior were determined by means of questionnaires. Assessment periods began 7 days before each part of the academic examination began and lasted until the 6th day afterward. A control group of 24 medical students who were not undergoing examinations also responded to all questionnaires. A progressive suppression of sIgA, outlasting the examination period by more than 6 days, was observed. Time spent studying explained a significant proportion in sIgA variation. However, no relationship between sIgA and URT symptoms was observed, nor did students who took academic examinations differ from untested controls in symptom rates.
Patients were recruited for hypnotherapy from a clinic for patients with frequently recurrent genital herpes simplex virus (rgHSV). Psychological and immunological parameters were measured 6 weeks prior to hypnotherapy and 6 weeks afterwards, during which time each patient kept a diary of symptoms of rgHSV. Following hypnotherapy there was a significant overall reduction in the number of reported episodes of rgHSV, accompanied by an increase in the numbers of CD3 and CD8 lymphocytes, which may represent a non specific effect of hypnosis. The improvers showed significant rises in natural killer (NK) cell counts, HSV specific lymphokine activated killer (LAK) activity, and reduced levels of anxiety when compared to non-improvers. NK cell numbers and HSV specific LAK activity may therefore be important in the reduction in rgHSV following hypnotherapy.
The effects of self-hypnosis training on immune function and mood were examined in medical students at exam time. Hypnosis involved relaxation and imagery directed at improved immune function and increased energy, alertness and concentration. Hypotheses were made about activated and withdrawn personality differences. Eight high and eight low hypnotically susceptible participants were given 10 sessions of hypnosis, one live and nine tape-recorded, and were compared with control subjects (N=12). CD3, CD4, CD8, CD19 and CD56 NK cells and blood cortisol were assayed. Life-style, activated vs. withdrawn temperament, arousal and anxiety questionnaires were administered. Self-hypnosis buffered the decline found in controls in NK (P<0.002) and CD8 cells (P<0.0.07) and CD8/CD4% (P<0.06) (45-35% order of magnitude differences) while there was an increase in cortisol (P<0.05). The change in NK cell counts correlated positively with changes in both CD8 cells and cortisol. Results were independent of changes in life-style. Energy ratings were higher after hypnosis (P<0.01), and increased calmness with hypnosis correlated with an increase in CD4 counts (P<0.01). The activated temperament, notably the cognitive subscale (speaking and thinking quickly), was predictive of exam levels of T and B lymphocytes (P&z.Lt;0.08-P<0.02), and reaching r=0.72 (P<0.001) in the non-intervention control group. The sizeable influences on cell-mediated immunity achieved by a relatively brief, low cost psychological intervention in the face of a compelling, but routine, stress in young, healthy adults have implications for illness prevention and for patients with compromised immunity.
This chapter reviews the effects of psychological interventions on immunity. It presents approaches that explicitly or implicitly relate to neurophysiology such as those that involve relaxation with and without imagery training, sometimes accompanied by neurophysiological monitoring. Training in guided imagery about strengthening immune function has been a popular technique incorporated with relaxation schedules and with the narrative often adapted to the nature of the patient's illness. Metaphorical images of a healthy immune system in a state of combat with invading viruses and germs may be invoked once the participant has been placed in a state of deep relaxation. The clinical benefits of imagery training, the marked reduction in recurrence of herpes simplex virus-2 (HSV-2), which is almost halved by 6 weeks of training and which occurs in patients who are chronic and severely ill, attests to the importance of the impact on the immune system of self-hypnosis training with directed immune-related imagery. There are also psychological benefits in the form of reductions in clinical anxiety and depression.
Several immune effects of asymmetrical brain lesions clearly demonstrate that each hemisphere plays a particular role in immunomodulation. The consistent observation of an association between lateralization and immune reactivity has led to important notions. Lateralization may represent a neurobehavioral trait linked to the activity of physiological systems involved in the response to external challenges (either intra- or interspecific). Therefore, the description of these associations should be a first step for delineating the personality of an individual, including various aspects of behavior, of brain metabolism, and of neuroendocrine and immune responsiveness, for predicting the responsiveness to stressful conditions. Because the communication pathways between the brain and the immune system involve the neuroendocrine system and, especially, the hypothalamic–pituitary–adrenal (HPA) axis as well as the autonomic nervous system, it may be hypothesized that the asymmetrical brain organization influences the reactivity of these systems. The role of lateralization in the modification of immune reactivity is investigated during the stress response. It represents an integrated response of the organism to environmental demands that involves the endocrine system, especially the HPA axis, and the sympathetic nervous system. Different stressors are used in mice to demonstrate the role of brain lateralization on various parameters of the stress response.
Transcranial magnetic stimulation (TMS) can activate discrete areas of the cerebral cortex through the intact skull of healthy conscious volunteers. A magnetic coil generates a brief and focused magnetic field that penetrates the skull to activate the specific area of cerebral cortex beneath. This non-invasive procedure is painless, well tolerated by participants and now widely used to explore brain function. We used TMS to investigate asymmetrical cortical regulatory influences on one aspect of immune function: secretion of the antibody immunoglobulin A (S-IgA) into saliva. The right and left temporo-parietal-occipital cortex of 16 healthy, conscious subjects was stimulated on two different occasions, at least 1 week apart. There was an immediate increase in S-IgA concentration following both right and left stimulation. Saliva volume was reduced immediately post-right but not left stimulation. When secretion (microg/min) of S-IgA was calculated (controlling for changing saliva volume) an increase was apparent following left but not right hemisphere stimulation. Furthermore, a significant difference between the relationship between S-IgA concentration and volume of saliva post-left and right stimulation was observed. We conclude that TMS can be used as a tool to investigate cortical regulation of autonomic and immune function in healthy, conscious human subjects and that secretion of saliva and S-IgA is differentially affected by stimulation of the left and right cerebral cortex.